NURSING PATIENT CARE POLICY & PROCEDURE
To provide guidance for registered nurses (RNs) and dialysis technicians to maintain site
care and patency of short-term and long-term (tunneled) hemodialysis/apheresis
A. Dual Lumen Hemodialysis (HD) catheters should not be routinely used for purposes
other than HD or apheresis (i.e., phlebotomy, IV administration). Do not use these
catheters unless you have consulted the nephrologist to obtain an order for use.
B. Triple Lumen (Trialysis) HD Catheters have two large bore lumens and one power
1. The arterial (red) and venous (blue) ports are for HD or apheresis use ONLY.
2. The power injectable lumen (purple) is used and maintained by bedside
nursing staff according to Nursing Patient Care Policy 1.56 AP, Central
Vascular Access Device Use, Maintenance and Removal (Adult & Pediatric)
and the UWHC Guidelines for Flushing/Locking of Venous Access Devices
in Adult and Pediatric Patients.
C. The red and blue ports of HD and apheresis catheters do NOT need to be aspirated
daily. They are maintained according to the UWHC Guidelines for Flushing/Locking
D. HD/apheresis catheter site care is routinely performed by the HD/apheresis nurse
prior to treatment, but if the dressing becomes visibly soiled prior to treatment the
dressing should be changed by the bedside nurse according to Nursing and Patient
Care Policy 1.56 AP, Central Vascular Access Device Use, Maintenance and
Removal (Adult & Pediatric). For details specific to HD/Apheresis catheters, see
E. If a HD/apheresis catheter is not being used for HD/apheresis, the catheter needs to be
flushed and maintained by the bedside nurse according to the UWHC Guidelines for
Flushing/Locking of VADs; site assessment and dressing change according Nursing
April 28, 2017
Nursing Manual (Red)
Policy #: 1.28AP
Title: Care of Hemodialysis/Apheresis
Catheters (Adult & Pediatric)
Page 2 of 6
Patient Care Policy 1.56 AP, Central Vascular Access Device Use, Maintenance and
Removal (Adult & Pediatric). Evaluate necessity daily with the healthcare team.
F. ICU, IMC, Infusion Center Nurses, and SOS RNs who have completed training and
competencies, they may discontinue HD/apheresis catheters, except cuffed and
tunneled catheters. Refer to UW Health Clinical Policy 2.3.14, Insertion,
Maintenance, and Discontinuation of Central Vascular Access Devices for Prevention
of Central Line-Associated Bloodstream Infection (CLABSI).
1. For adult patients not in IMC or ICU, page SOS for catheter removal.
2. For pediatric patients in non-critical care areas, contact pediatric critical care
unit for catheter removal.
III. USE OF HD/APHERESIS CATHETERS
2. Sterile drape
3. Non-sterile exam gloves
4. 4x3 gauze
5. Chlorhexidine tincture (ChloraPrep®)
6. Two (2) 10 mL normal saline syringes
7. 4% citrate, heparin, or Alteplase (as ordered) in 5 mL syringes
8. Two (2) sterile needleless connectors or 2 TEGO
9. For Pediatric patients use a central line access kit.
B. Accessing HD/apheresis catheters
1. HD/apheresis catheter lumens should not be routinely used for purposes other
than HD or apheresis (i.e., phlebotomy, IV administration). Do not use these
catheters unless you have consulted the nephrologist to obtain an order for
2. Perform hand hygiene according to UW Health Clinical Policy 4.1.13, Hand
Hygiene, and don non-sterile gloves before accessing a HD/apheresis catheter.
3. Apply mask to self and patient.
4. Place sterile drape under ports of catheter.
5. To access catheter using TEGO
Connector, swab with 70% alcohol or
chlorhexidine tincture for 15 seconds. Attach a luer lock syringe by entering
straight into the center, tightening until the collar of the syringe touches the
ridge of the TEGO
device. DO NOT OVER TIGHTEN.
6. If removing/replacing TEGO
or needless connectors scrub arterial and
venous ports for one (1) minute with chlorhexidine tincture (ChloraPrep®)
and allow to dry.
7. For adult patients, aspirate 5 mL of blood from each port and discard.
8. For pediatric patients, aspirate 3 mL blood and discard.
C. Assessing lumen patency
1. Assess patency prior to and after each use.
2. Flush each port with at least 10 mL of normal saline to check for patency of
port and resistance of lumen. If resistance is felt, DO NOT FORCE. Check to
see that the clamp is open and the tubing is not kinked. Notify the physician.
Consider the need for tPA or Alteplase to declot the catheter. Refer to UWHC
Nursing Patient Care Policy 1.56 AP, Central Vascular Access Device Use,
Maintenance and Removal (Adult & Pediatric).
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D. Drawing blood specimens
1. Do not use the HD/apheresis catheter unless you have consulted the
nephrologist to obtain an order for use.
2. When collecting blood from a catheter, withdraw 5-10 mL of waste into a
discard tube/syringe in red sharps container prior to collecting specimens to
3. When drawing blood specimens from a catheter that has been locked with an
anticoagulant, coagulation tubes (light blue) should be collected by
venipuncture. If venipuncture is not possible, extra blood must be aspirated to
a. Draw the light blue tube last after 20 mL of blood (10 mL for pediatric
patients but also consider the maximum draw volume that is allowed
as appropriate. Refer to Maximum Blood Draw Guideline for
Pediatric Patients) has been withdrawn for other testing or waste. Just
prior to drawing the light blue tube, draw one (1) mL into a discard
light blue tube to prevent cross contamination from the additive of the
tube drawn previously.
b. Do not re-infuse wasted blood due to infection risk and the potential
for small clots in the specimen. For pediatric patients, the RN may
return the waste collected from a closed system to the patient
immediately after the draw is complete. A closed system ensures the
blood is kept sterile.
c. Draw laboratory specimens as outlined in Nursing Patient Care Policy
1.56 AP, Central Vascular Access Device Use, Maintenance and
Removal (Adult & Pediatric).
4. Blood Cultures: Do not use the HD/apheresis catheter to draw blood cultures
unless you have consulted with the nephrologist to confirm that culture form
the HD/apheresis catheter has been ordered in conjunction with a peripheral
specimen for culture. Refer to UW Health Clinical Policy 2.5.6, Blood
Cultures for Adult Patients for specific instructions. For pediatric patients
refer to Clinical Laboratory Policy 1507.P014, Blood Culture Collection.
E. Locking HD/apheresis catheters
1. HD/apheresis catheters may be capped with either needleless connectors or
Connectors may be placed on arterial and
venous lumens of HD catheters by HD, SOS or ICU staff.
2. Locking procedure for catheters with needless connectors:
a. For Pediatric patients, use a Central line access kit.
b. After flushing, fill each lumen with anticoagulant as ordered, referring
to the UWHC Guidelines for Flushing/Locking of VADs and cap each
port with a needleless connector.
i. Prepare the correct volume of ordered anticoagulant.
• Read the volume printed on each lumen and add 0.2 mL
for adults or 0.1 mL for pediatric patients.
• If no volume is printed on the catheter, check for a label
on the catheter ports or the dressing indicating the
volume used last time.
• If still unable to ascertain volume of catheter, use the
volume recommended in the UWHC Guidelines for
Flushing/Locking of VADs.
Page 4 of 6
ii. Rapidly infuse anticoagulant into each lumen of catheter and
end flush with positive pressure (push clamp shut while
iii. Cap off each port with sterile needleless connector.
iv. Document concentration and fill volume of anticoagulant used
on catheter label and in the clinical record.
3. Locking procedure for catheters with TEGO
Connectors are intended solely for use with HD/Apheresis
catheters and may be used instead of standard needleless connectors.
i. Attach male luer TEGO
Connector to vascular access device.
ii. Flush with normal saline and apply label with date.
• Attach a 10 mL normal saline syringe and infuse 8-9
mL. Create positive pressure by closing the clamp
while instilling the last few milliliters. (Do not empty
the syringe completely as it causes blood to reflux back
into the catheter.)
• For Pediatric patients, use a Central Access kit.
• NOTE: Anticoagulants are not routinely required with
Connector. If locking catheter with an
anticoagulant (i.e., 4% citrate, heparin or alteplase),
label with date and type of locking solution.
Connectors are changed every seven (7) days.
a. DO NOT PLACE ANY caps on the TEGO®
Connector. It is a closed device.
b. Do not use needles to access.
c. Clamp line before disconnecting from TEGO
IV. FLUSHING APHERESIS CATHETERS FOR PEDIATRIC PATIENTS WHO
ARE NO LONGER ON APHERESIS
Pediatric Oncology patients may have a dialysis catheter placed for apheresis stem cell
extraction. After the stem cells have been harvested, the catheter may be used in place of
a Hickman-type catheter. Refer to the flushing guidelines for Hickman-Type Catheter in
UWHC Nursing Patient Care Policy 1.56 AP, Central Vascular Access Device Use,
Maintenance and Removal (Adult & Pediatric).
V. SITE CARE AND MAINTENANCE
A. Site care will be performed according to Nursing Patient Care Policy 1.56 AP Central
Vascular Access Device Use, Maintenance and Removal (Adult & Pediatric).
1. Any RN trained in central vascular access device (CVAD) care may perform a
2. Masks are required on patient and nurse during site care.
Page 5 of 6
3. The Tegaderm CHG dressing is the standard dressing for all central vascular
access devices (CVAD).
VI. HD/APHERESIS CATHETER REMOVAL
A. Temporary non-tunneled HD/apheresis catheters may be removed by trained nurses
according to UW Health Clinical Policy 2.3.14, Insertion, Maintenance, and
Discontinuation of Central Vascular Access Devices for Prevention of Central Line-
Associated Bloodstream Infection (CLABSI).
VII. UW HEALTH CROSS REFERENCES
A. UW Health Clinical Policy 2.3.14, Insertion, Maintenance, and Discontinuation of
Central Vascular Access Devices for Prevention of Central Line-Associated
Bloodstream Infection (CLABSI)
B. UW Health Clinical Policy 2.5.6, Blood Cultures for Adult Patients
C. UW Health Clinical Policy 4.1.8, Standard Precautions Isolation
D. UW Health Clinical Policy 4.1.13, Hand Hygiene
E. UWHC Clinical Laboratory Policy 1507.P014, Blood Culture Collection
F. Nursing and Patient Care Policy 1.56 AP, Central Vascular Access Device Use,
Maintenance and Removal (Adult & Pediatric)
G. Nursing and Patient Care Policy 3.11AP, Continuous Renal Replacement Therapy
(CRRT) Using the NxStage System One Machine (Adult & Pediatric)
H. UW Health Flushing/Locking of Venous Access Devices - Adult and Pediatric –
Inpatient/Ambulatory Clinical Practice Guideline
I. Laboratory Guidelines. Order of Draw of Blood Collection Tubes. Found at
A. Gomez, N. J., (Ed). (2011). Nephrology nursing scope and standards of practice (7
ed., pp. 123-144). Pitman, NJ: American Nephrology Nurses’ Association.
B. Hospital Infection Control Practices Advisory Committee (HICPAC) (2011).
Guidelines for the Prevention of Intravascular Catheter-Related Infections.
C. Infusion Nurses Society (2011). Intravenous Nursing Standards of Practice. Journal
of Infusion Nursing, 34(1S), S1-S96.
D. Lynn-McHale Wiegand, D. J. (Ed.) (2011). AACN Procedure Manual for Critical
Care. Philadelphia, PA: W.B. Saunders.
E. Agharazii, M., Plamondon, I., Lebel, M., Douville, P., Desmeules, S. (2005).
Estimation of heparin leak into the systemic circulation after central venous catheter
heparin lock. Nephrology Dialysis Transplantation, 20(6), 1238-40.
F. Grudzinski, L., Quinan, P., Kwok, S., Pierratos, A. (2007). Sodium citrate 4% locking
solution for central venous dialysis catheters-an effective, more cost-efficient
alternative to heparin. Nephrol Dial Transplant, 22, 47.
G. National Kidney Foundation. (2006) KDOQI Clinical Practice Guidelines and
Clinical Practice Recommendations for 2006 Updates: Hemodialysis Adequacy,
Peritoneal Dialysis Adequacy and Vascular Access. Am J Kidney Dis, 48:S1-S322,
2006 (suppl 1).
Page 6 of 6
Connector information available from ICU Medical, Inc. online at:
IX. REVIEWED BY
Assistant Director, Clinical Labs
Clinical Infection Control Practitioner, Infection Control
Clinical Nurse Specialist, Trauma & Life Support Center
Clinical Nurse Specialist/Nurse Practitioner, Hem/Onc, Palliative Care Pediatrics
Clinical Nurse Specialist, Pediatric Intensive Care Unit
Nurse Manager, Inpatient Hemodialysis
Nursing Patient Care Policy and Procedure Committee, April 2017
Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive